GP advice service boosts continuity of care

A service connecting GPs with rapid clinical advice from non-GP specialists has reduced the need for GPs to refer patients to outpatient departments and better supports clinical decision-making.

Funded by the Queensland Government, the Mater Queensland eConsult service has been running as a statewide program since October last year, providing virtual clinical advice within days to GPs.

Free at the point of care to patients and GPs, the model links GPs with 16 different physician sub-specialties via the secure messaging platform Consultmed.

These include endocrinology, cardiology, dermatology, infectious disease, haematology, neurology and nephrology as part of an ever-expanding list of options.

At a GP’s request, specialists advise on areas such as patient management, monitoring or diagnosis, while at the same time helping overcome common challenges patients face accessing specialist services, such as high costs, delays, deteriorating health and travel distance. All Requests for Advice (RFA) need to meet outpatient department categorisation criteria.

Evaluation data shows 82% of patients can then be managed by their GP and don’t require a face-to-face appointment with the advising specialist.

Inspired by the eConsult program in Ontario, Canada, the program was adapted to the Australian context in 2018 by former RACGP President Professor Claire Jackson and the team at the University of Queensland/MRI Centre for Health System Reform and Integration.

‘Increasingly, as GPs, we were noticing that a lot of our Category 3 and older patients in particular were not receiving the timely support they needed in an increasingly stretched health environment,’ Professor Jackson told newsGP.

‘Often GPs and their patients would come to the point where they needed additional advice regarding decision-making, but that didn't necessarily translate to needing to get into the car and drive to an outpatient clinic for a clinical examination, or delay assessment for months.’

The program was first implemented in two Primary Health Networks, and after further research evaluated its positive impact, outcomes and cost savings, it attracted state funding support late last year of $6 million over three years.

To date, the service has just passed 1700 requests for advice and is expanding the number of specialties offered by around two per month.

As United Kingdom GPs grapple with new rules requiring they seek advice from specialists prior to referring patients within the National Health Service, those involved with eConsultant in Australia point to a very different approach.

eConsultant works under the existing Medicare billing model – GPs who request advice can do so via normal time-based billing. For specialists providing the advice, there is an activity payment funded via the service.

While there are obvious benefits in rural areas where healthcare services can be more difficult to access, the program is also helping overcome urban challenges – particularly for GPs working with vulnerable populations with language, transport or access issues.

In the area of paediatric dermatology, for example, where delays faced by patients for outpatient services can be long, GPs have been able to use eConsultant to carry on with caring for their patient within a primary care environment.

‘If you have cystic acne and you live in Blackall, Cloncurry or Cairns, access to Roaccutane, which at the moment can only be authorised by a dermatologist, is well-nigh impossible – and non-treatment can result in facial scarring for life,’ Professor Jackson said.

‘We can’t underbake just how critical access to diagnosis and management can be but also meeting growing regulations for accessing life-changing drugs across many specialities, especially in rural and remote areas.

‘But we are finding it is not just an urban versus rural divide – vulnerable people in urban areas are also likely to miss out on assessment.’

Requests for advice can often be easily initiated within a standard consultation, with consent from patients obtained, the GP sending through the RFA, and patients booking a follow-up GP appointment for the following week or so.

Professor Jackson says questions have been diverse, relating to diagnostic support (especially dermatology), issues in monitoring complex patients with changing clinical conditions, medication concerns and authorities, or often, confirming if a chosen course of action was appropriate.

Advice is assured within three business days and usually arrives much earlier, with program data showing a mean current response time of 1.7 days.

The program constantly monitors feedback from patients as well as GPs and all participating specialists.

‘We receive powerful stories from our users about the positive impact on access, cost and travel to receive care,’ Professor Jackson explains.

‘Some outer-urban patients would have to take several busses and a train to get to the particular outpatient services they need, which can be particularly difficult if they are heavy users of that service. One rural patient indicated the service saved an 800-kilometre round trip, and really made a difference.’

Professor Jackson says the model has wide potential to be picked up in other state and territories, with Australian Capital Territory providers taking recent steps to learn more about how it works.

‘We’d like to thank the Crisafulli Government for their vision and commitment in expanding this service statewide and love to see all states and territories look at the huge potential in improved access, health status and cost saving the model offers,’ she said.

‘Our team is very happy to share what we’ve learned ,and the increasing impact we are seeing as the model expands is being carefully evaluated and reviewed.

‘This service offers an opportunity for governments and the hospital environment to utilise a well- evaluated, high-performing model that best meets the needs of patients, communities, and both primary and secondary care clinicians in challenging service environments.’

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GP advice hospital services non-GP specialists vulnerable patients